By Gary Schubach, Ed.D., A.C.S.

A major area of continued controversy and debate among sex researchers, gynecologists and sex educators has been and continues to be the question of the phenomenon known as “female ejaculation.” The current study was an exploratory research experiment designed to provide information about this issue by catheterizing seven women, who reported that they regularly expelled fluid during sensual and/or sexual arousal. The paper itself includes an extensive review of previous research in the areas of female ejaculation, the G-Spot, and the urethral glands and ducts. Also discussed are the relevant social issues and how they interact with the biological questions.

Evidence from various studies of live subjects, involving in total less than fifty women, had shown, at least in these subjects, that what was being considered was a urethral expulsion. However, with the total number of women studied being so small, it was impossible to rule out the possibility that some woman somewhere is expelling fluid other than through the urethra. While the current experiment, based upon a review of previous studies, focused on the nature, composition and source of female urethral expulsions during sensual arousal, this researcher was certainly open to observing, capturing and analyzing any expulsions other than from the urethra.

With catheterization, the bladder could be isolated from the urethra so that it could be reliably determined which fluids came from which area. The fluids obtained could then be analyzed for their individual composition, having lessened the possibility that they had been mixed in the urethra.

The entire experiment was videotaped with a medical doctor and/or a registered nurse present at all times. The overall environment was designed to be as comfortable and natural as possible for the women subjects in order to increase the probability that there would be fluid to be collected.

The primary conclusion from the experiment was that almost all the fluid expelled from these seven women unquestionably came from their bladders. Even though their bladders had been drained, they still expelled from 50 ml to 900 ml of fluid through the tube and into the catheter bag. The only reasonable conclusion would be that the fluid came from a combination of residual moisture in the walls of the bladder and from post draining kidney output.

There was also a consistency of results that showed a greatly reduced concentration of the two primary components of urine, urea and creatinine, in the expelled fluid. A review of previous literature leads to an inference that it is possible that the expelled fluid is an altered form of urine and that there may be a chemical process that goes on during sexual stimulation and excitement that changes the composition of urine.

On four occasions the research team saw evidence of milky-white, mucous-like emissions from the urethra outside of the catheter tube. Although three of those emissions were recorded by the video cameras, the research team was only able to capture a small portion of the fluid for laboratory analysis. An objective reading of the previous literature indicated the possibility of such an emission from the urethral glands and ducts.

In the past, the assumption has been that female urethral expulsions during sensual and/or sexual activity originated eitherin the bladder or from the urethral glands and ducts. The current study, which documented expulsions originating in the bladder, also indicated the possibility that, in some women, there may also be an emission from the urethral glands and ducts. That possibility seems promising enough to encourage future researchers to employ methodology similar to this study to resolve this age old controversy.

A major area of continued controversy and debate among sex researchers, gynecologists and sex therapists has been and continues to be the question of the phenomenon known as “female ejaculation.” Perhaps no one sexual issue, including the question of clitoral vs. vaginal orgasms, has created so much public interest. On the one hand, there have been persistent and numerous anecdotal reports by women and their sexual partners, over thousands of years, of an expulsion of fluid by women during sex that did not seem to have the appearance or smell of urine and did not stain the bed sheets. At the same time the medical establishment has been almost totally unwilling to give serious consideration to evidence of a cause other than urinary stress incontinence.

This project is an exploratory research experiment which attempts to shed light on this controversy by catheterizing seven women who report that they regularly expel fluid during sensual and/or sexual arousal so as to effectively segregate the bladder from the urethra and collect vaginal fluid expulsions in a controlled, medically supervised environment.

Evidence from various studies of live subjects, involving in total less than fifty women, has shown, at least in these subjects, that what was being considered was a urethral expulsion. However, with the total number of women studied being so small, it is impossible to rule out the possibility that some woman somewhere is expelling fluid other than through the urethra.

While the current experiment, based upon a review of previous studies, focuses on the nature, composition and source of female urethral expulsions during sensual arousal, this researcher was certainly open to observing, capturing and analyzing expulsions other than from the urethra.

Chapter 1

METHODOLOGY

The experiment was constructed for the current study to take a urine specimen from the female subjects while in a resting state. The initial urine was analyzed for 2 factors, urea and creatinine.

The female subjects then began an arousal period of at least an hour in whatever manner was preferable to them before the actual insertion of the Foley catheter. The choices that were utilized were manual self stimulation, manual stimulation by a partner, and/or use of a non-mechanical acrylic device known as a Crystal or G Spot wand.

After the subjects indicated that they felt properly stimulated and ready, the catheter was inserted and the balloon filled so as to form a seal with the bladder neck. Their bladders were drained and the collection bag was changed. The bag with the drained fluid was saved for analyses for the same 2 factors, urea and creatinine.

Then, with the catheter in place, the subjects were asked to resume stimulation and achieve what they considered to be an ejaculatory orgasm in whatever manner was preferable to them except intercourse, due to the catheter. The choice of stimulation employed were again manual self stimulation, manual stimulation by a partner, and/or use of the G Spot wand.

Any expulsion of fluid through the catheter tube went into the new bag for analysis for the same 2 factors, urea and creatinine. If any fluid was expelled outside the tube and bag, an attempt was made to collect it in a specimen container and it was analyzed for fructose and glucose. If there had been any indication of these prostatic components, then tests would have been done for the presence of Prostate Specific Antigens.1

A perineometer test was administered before the arousal period began to measure the pelvic muscle strength of our subjects. The purpose was to compare the readings with those from research on urinary stress incontinence and previous perineometer testing done by Arnold Kegel, M. D. among others.2

The entire experiment was videotaped with a medical doctor and/or a registered nurse present at all times. The overall environment was designed to be as comfortable and natural as possible to increase the probability that there would be fluid to collect.

A sex history was taken on all subjects along with questions pertaining to the phenomenon being studied (see Appendix A). Examples of such questions included, but were not limited to, when the female subjects began to experience a discharge of fluid, whether they had done anything to train themselves to facilitate a discharge, and how they feel about the discharge. The questionnaire was also designed to ask many of the same questions that were asked in a number of previous studies.3

In addition, a medical history was taken on each subject and information was distributed about the possibility of bladder or urethral irritation or infection from the experiment, with a procedure set up for follow-up treatment should any symptoms appear. A full signed consent form was obtained.

With catheterization, the bladder could be isolated from the urethra so that it could be reliably determined which fluids came from which area. The fluids obtained could then be analyzed for their individual composition while lessening the possibility of mixture in the urethra. One concern about the catheter that was expressed and considered was the idea that the catheter tube might physically block an expulsion of fluid from the urethral glands and ducts. That seemed to be a reasonable concern, so the research team experimented with ever smaller sizes of catheter tubes, starting out with a 12 FR in the initial trial and progressing to an 8 FR for the final testing session. While it is still possible that the urethral glands and ducts were blocked, the research team was reluctant to discard the use of the Foley catheter as it appeared to be the best way to isolate the bladder from the urethra.

In two initial trials, procedures were checked and validated in terms of being able to produce an expulsion while the catheter was in place. The final testing date occurred on July 27, 1996, when six of the seven subjects were tested.

Chapter 2

LITERATURE REVIEW

From a review of well over 100 books, articles and other reference sources, it is impossible to look at the question of vaginal expulsions and not also to some extent consider the material on the urethral ducts and glands and on the so called Gräfenberg Spot. No direct connection has been conclusively established between vaginal expulsions, the Gräfenberg spot, and urethral ducts and glands. However, while these are three distinct entities, most of the previous researchers saw the possibility of some interconnectedness, if for no other reasons than their physical proximity and the anecdotal reports of women.4 For these reasons, the significant history of all three areas will be reviewed.

VAGINAL EXPULSIONS

The expulsion of fluid from the vagina during sexual arousal and/or orgasm has been reported throughout time. There were many references to such historic scientific figures such as Aristotle and Galen discussing and identifying vaginal expulsions. The first modern description both of female genitalia and the question of vaginal expulsions came from the 17th century Dutch physician, Regnier De Graaf. He stated:

“The urethra is lined internally by a thin membrane. In the lower part, near the outlet of the urinary passage, this membrane is pierced by large ducts, or lacunae, through which pituito-serous matter occasionally discharges in considerable quantities. Between this very thin membrane and the fleshy fibres we have just described there is, along the whole duct of the urethra, a whitish, membranous substance about one finger-breadth thick which completely surrounds the urethral canal….The substance could be called quite aptly the female prostatae or corpus glandulosum, ‘glandulous body.’ It seems to us too to be what Galen is talking about when, in Book 14 of this work on the use of the parts, he writes, on the authority of Herophilus, that women as well as men have glandulous ‘prostatae.’”5

There were also many references to vaginal expulsions in classical literature, although it is impossible to determine whether these passages are simple reporting of what the writer saw, or a romanticized fictional version of popular male sexual fantasies of the times. In the twentieth century, people such as Robert Latou Dickinson and Havelock Ellis believed that the fluid came from the cervix. Others felt that the secretions came from Bartholin’s glands or a combination of Bartholin’s glands and cervical secretions.6

In 1950, the German obstetrician, Ernst Gräfenberg, wrote of observing the expulsion of fluid from the urethra.

“If there is the opportunity to observe the orgasm of such women, one can see that large quantities of a clear, transparent fluid (that) are expelled not from the vulva, but out of the urethra in gushes. At first, I thought that the bladder sphincter has become defective by the intensity of the orgasm. Involuntary expulsion of urine is reported in sex literature. In the cases observed by us, the fluid was examined and it had no urinary character. I am inclined to believe that ‘urine’ reported to be expelled during female orgasm is not urine, but only secretions of the intraurethral glands correlated with the erotogenic zone along the urethra in the anterior vaginal wall. Moreover, the profuse secretions coming out with the orgasm have no lubricating significance, otherwise they would be produced at the beginning of intercourse and not at the peak of orgasm.”7

A few years later, Alfred Kinsey, in his landmark work, Sexual Behavior in the Human Female, states a different point of view when he writes:

“Since the prostate gland and seminal vesicles are only vestigial structures in the female, she does not actually ejaculate. Muscular contractions of the vagina following orgasm may squeeze out some of the genital secretions, and in a few cases eject them with some force. This is frequently referred to, particularly in the deliberately exotic literature, as an ejaculation in the female; but the term cannot be strictly used in that connection. Ejaculation is, in fact, the only phenomenon in the physiology of sexual response which is not identically matched in the male and the female, or represented by closely homologous functions.”8

In 1966, Masters and Johnson in their book, Human Sexual Response, dismiss “female ejaculation” as an “erroneous but widespread concept.”9 In their 1982 book, Masters and Johnson on Sex and Human Loving, they further state that “despite a popular misconception, most women do not ejaculate during orgasm. The erroneous belief that women ejaculate probably stems from descriptions in erotic novels of fluid gushing from the vagina as a woman writhes and moans at the peak moment of sexual passion. Such descriptions are not particularly accurate.”10 They do later admit that “although it is clear that at least some women experience this ejaculation-like response, it should be realized that a number of these cases represent a condition called urinary stress incontinence in which urine is expelled from the urethra due to physical straining such as occurs with coughing, sneezing or sexual arousal. Since this condition is usually correctable, either by the use of Kegel exercises or minor surgery, medical evaluation is warranted if a women is bothered by such a response.”11

Prior to the early nineteen eighties, when live subjects began to be tested, most of the literature on the subject of vaginal expulsions came from one of three general categories. First, from reviews of historical writings that anecdotally described vaginal discharges that did not appear to have the smell or color of urine or that left stains on bedding. Secondly, from analyses of anatomy books that described the homologous organs and processes of the male and female reproductive systems, and then semantically, with an attempt at logic, drew a conclusion that vaginal expulsions at orgasm were at least theoretically possible.

Later, there were two excellent statistical studies of the anecdotal experiences and knowledge of selected women regarding “female ejaculation,” the Gräfenberg spot, and sexual responsiveness.12 In these two studies, an anonymous questionnaire was distributed to 2,350 professional women in the United States and Canada and 55% were completed and returned. The researchers chose professional women on the theory that they would have a superior understanding of physiology and the terminology involved. Among the principal findings of these studies was that 58.8% of the respondents had read about “female ejaculation” and 39.5% reported having experienced an expulsion of fluid at orgasm at some time.13 Moreover, it was found that 65.9% of the respondents perceived a sensitive area in their vaginas. Of those, 72.6% reported experiencing orgasm from stimulating that area during sexual arousal and 82.3% of them indicated that they had at some time also experienced ejaculation.14 An additional interesting finding was that 59.3% of those experiencing orgasm did not require simultaneous clitoral stimulation to achieve orgasm.15

Finally, beginning in the early nineteen eighties, a series of studies attempted to scientifically study the phenomenon as it occurred, by creating experiments designed to observe the expulsions and obtain samples of the liquid for analysis. The first of those case studies (Addiego, et al, 1981) involved only one subject. Specimens were “obtained by having the woman hold a clean glass firmly against the perineum while she lay in a supine position, knees flexed, with her feet resting on a bed.” 16 Analyses of the specimens showed that concentrations of prostatic acid phosphatase (PAP) were significantly higher while concentrations of urea and creatinine, primary components of urine, were significantly lower in the four expulsion specimens than in three urine specimens from the same subject. The authors concluded that, “the dissimilarity of chemical composition of the orgasmic expulsion and urine specimens indicates that the expulsion in this subject was not a manifestation of urinary incontinence.”17 They also hypothesized that “the expulsion is largely a glandular secretion” and that, “the PAP suggests that at least part of the glandular secretion came from prostatic tissue.”18

This study was later criticized for its collection procedures and for the tests used to determine levels of PAP in both the expulsion and urine specimens.19 PAP was later discovered to occur naturally in vaginal secretions.20 Also, the authors did not consider the possibility that part of the fluid might be coming from the bladder and mixing with any urethral gland expulsion in the urethra. To them it was a question of either the fluid was urine coming from the bladder or ejaculate coming from the urethral glands.

The next scientific effort to collect and analyze vaginal expulsions came in a study by Goldberg, et al (1983), of eleven women, six of who claimed to be ejaculators. Analysis of the expulsions of the six ejaculators “failed to detect elevated levels of prostatic acid phosphatase and the substance appeared similar in biochemical properties to urine.”21 However, this study, for the first time, suggested that “one alternative explanation for the existence of a ‘unique’ ejaculate is that the chemical composition of urine changes during sexual stimulation and excitement. Perhaps the ejaculate is merely an altered form of the woman’s urine.”22

Subsequent to the Goldberg study, Edwin G. Belzer, Jr., Beverly Whipple and William Moger, co-researchers with Addiego, et al (1981), released a study in 1984 involving seven women mentioned in Addiego but whose results were not reported because the specimens were “collected in the absence of the research team.”23 Because of concerns that the findings of Goldberg might discourage scientists from making the commitment of resources necessary to do further research, they decided to release the analyses of the specimens of the seven women. Some of the tests were incomplete as there were insufficient quantities of ejaculate to compare with the urine specimen. However, in three of the cases, acid phosphatase and glucose were reported to be present in greater quantities and urea and creatinine in lesser quantities in the ejaculate than in the urine sample. In the other four cases, acid phosphatase was detected in the ejaculate but not in the urine. These results were certainly more encouraging than those of Goldberg for those supporting the concept of “female ejaculation”.

The next major study of female vaginal expulsions with live subjects did not come until 1988. Milan Zaviacic, M. D., Ph.D., head of the Institute of Pathology, Comenius University Bratislava published a study of five women who were patients at a fertility department of a hospital of gynecology and obstetrics. Total samples from one of the participants and one of four samples from a second participant were collected in the laboratory. The rest were collected at the homes of the women and transported to the laboratory in ice. In four of the five cases, the samples were analyzed within three hours of collection, with the fifth subject’s specimens analyzed three months after collection. The results in all five cases showed a higher concentration of fructose in the ejaculate sample than in the urine sample. Zaviacic concluded that, “The determination of a higher fructose level in the ejaculate than in the urine suggests that the female ejaculate cannot be simply regarded as urine although urine is a regular component of the fluid of urethral expulsions at ejaculation.”24 Further, he states, “The release of fructose into the fluid of expulsions emphasizes the need to broaden our notion on the mechanism of the urethral ejaculation phenomenon in the female.”25

In a 1993 paper in the Journal of Sexual Research , Zaviacic states that, “The phenomenon of female ejaculation exists. Based on the previously mentioned research, one could conclude that some women expel a fluid from the urethra during sexual response that is similar to urine and may be related to urinary stress incontinence, and others expel a fluid that is different from urine.”26

PARAURETHRAL AND PERIURETHRAL GLANDS AND DUCTS

First, it is necessary to define terms. Para means “near, alongside of, a departure from the normal.” Peri means “around and about.”27 When used to describe the ducts and glands of the urethra, both are not as precise as simply referring to the ducts and glands that surround the urethra. However, to avoid confusion and not to hang up on semantics, for purposes of the literature review, they will be used interchangeably in whatever form was used by the individual authors.

Again, there were references by both Galen and Aristotle to the “female” prostate. As discussed earlier, De Graaf, in his 1672 work, New Treatise, Concerning the Generative Organs of Women, describes with detailed drawings, a “female” prostataeor corpus glandulosum.28 This clearly was the existing paradigm for more than two hundred years.

Modern science first began to address the question of the nature of the urethral ducts and glands in 1880. In that year Alexander Skene, M. D., professor of gynecology in the Long Island College Hospital in Brooklyn, New York, wrote a paper describing various glands and ducts surrounding the female urethra. He made diagrams of these glands and, subsequently, they were named for him.29 Later, in 1922, Franklin P. Johnson, M. D., made a case for the urethral glands and the urogenital sinus glands (Skene’s glands) being homologous to the prostate gland in the male. He goes on to detail the nature of these structures and speculates that they were capable of a secretion into the urethra but that they appeared to have no current anatomical function.30

Almost twenty years later, in 1941, George Caldwell, M. D., wrote that Skene’s glands could vary in degree of development from woman to woman. Further, he stated, “they possess a structure and elaborate a secretion comparable only to the prostatic glands of the male…. They are embryonic remnants which may have no essential function in the female, but which are apparently capable of some response to functional stimuli in the normal female, as indicated by the frequent occurrence of retained secretion within the glands.”31

In 1943, John Huffman, M. D., an obstetrician and gynecologist, conducted research on Skene’s glands and came to the conclusion that the extent of the glands and ducts surrounding the urethra had been greatly underestimated by Skene.32 In 1948, Huffman wrote that he saw general acceptance of the paraurethral ducts and their glands being homologues of the prostate, but the extent and detailed anatomy of those structures remained controversial.33

In 1953, Samuel Berkow, M. D., a urologist, came to the conclusion that the tissue of Skene’s glands was erectile and could be viewed as a “corpus spongeosum.” However, Berkow’s primary interest was in urination and he believed that the function of the “erectile tissue” was to pinch off the urethra in order to control urination. He never explored the question of under what conditions it would become erect.34

It should be noted that Skene, Johnson, Caldwell, Huffman and Berkow all represented mainstream medical thought and were published in such prestigious journals as The American Journal of Obstetrics and Gynecology, The Archives of Surgery andThe Journal of Urology. Conspicuously absent from the literature review for this period of time were any articles criticizing their conclusions. These are all articles that medical students were, and still are, required to read.

In the early 1980’s, there were several papers written regarding immunohistochemical identification of prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) in the female paraurethral and/or periurethral glands and ducts. In 1984, Pollen and Dreilinger found the presence of periurethral glands in seven out of ten women whose urethras were examined at autopsy. In all of the seven cases where the glands were found, immunoperoxidase staining showed a positive reaction for the presence of PAP in the glandular acini. A positive reaction for PSA was observed in four out of seven of the cases. The authors concluded that their findings supported the existence of a female homologue of the male prostate.35

Tepper, et al, (1984) found the presence of paraurethral glands in 18 out of 19 women, age 0-86 at autopsy, and a positive tissue reaction to PSA in 83% of the cases and to PAP in 67%. They concluded that their “study demonstrates the homologous nature of the female paraurethral glands and the prostate and supports speculations about functional similarity.”36

In 1984 and 1985, Zaviacic released the results of studies utilizing autopsies of fourteen women of childbearing age, chosen randomly, who had died of accidental causes and upon whom autopsies were carried out within eight hours following death. In these studies, Zaviacic found the presence of the same fifteen enzymes in the female urethral tissue that are also present in the male prostate. Furthermore, Zaviacic states, “In some of the analyzed cases, however, the glands or ducts were observed only in some histological sections, while in others no components of the female prostate could be found. In these cases the volume and secretory capacity of the female prostate must be minimal. On the other hand, in some women such rich conglomerates of prostatic glands filled with secretion were found that on histologic examination these pictures might easily be mistaken for male prostatic tissue.”37 To summarize his findings as to the paraurethral glands and ducts, Zaviacic concluded that what had been called Skene’s glands and/or paraurethral ducts and glands are, in fact, not a vestigial homologue of the male prostate but, instead, a “small, functional organ that produces female prostatic secretion and possesses cells with neuroendocrine function, comparable to the male prostate.”38

THE G SPOT

Perhaps the most misunderstood area in the three seemingly interconnected subjects of vaginal expulsions, the urethral glands and ducts, and the G spot, is the G spot. The term was first introduced to the public at large in the book, The G Spot and Other Recent Discoveries About Human Sexuality. It referred to a 1950 article in the International Journal of Sexology in which Ernst Gräfenberg, M. D., an ob/gyn, wrote about, among other things, erotic sensitivity in the anterior vaginal wall. He clearly states that it is his opinion that what he is feeling through the anterior vaginal wall is erectile tissue like the “corpora cavernosa.” He states that during sexual arousal “the female urethra begins to enlarge and can be felt easily. It swells out greatly at the end of orgasm. The most stimulating part is located at the posterior urethra where it arises from the neck of the bladder.”39 At no time in his article does Gräfenberg use the word “spot.”

In the book, The G Spot and Other Recent Discoveries About Human Sexuality, there is a reference on page 45 on how to find the G spot. It reads “To the finger, the G spot feels like a small bean, and, when stimulated, it may swell to the size of a dime or sometimes becomes as large as a half dollar.” While the authors make clear, if you read their entire book, that they also feel that the G spot is the place on the anterior wall of the vagina where the tissue surrounding the urethra can be felt, the popular press has promulgated the notion of a “spot.” As has been noted in the earlier literature review section on the female urethral glands and ducts, the size and development of these tissues will vary greatly from woman to woman and will change during arousal. The search for a “spot” on the anterior wall of the vagina as opposed to through the anterior wall as in the preceding definition, may be contributing to the difficulty of finding the “G spot.”

One particularly concise and accurate definition of the G spot appears in Our Sexuality (Crooks & Baur), a widely used college text on human sexuality:

“The Gräfenberg spot is an area located within the anterior (or front) wall of the vagina, about one centimetre from the surface and one-third to one-half way in from the vaginal opening. It is reported to consist of a system of glands (Skene’s glands) and ducts that surround the urethra. This area is believed to be the female counterpart of the male prostate gland and to develop from the same embryonic tissue.”40

There have been studies that have indicated that the stimulation of the G spot by itself may induce an orgasm that feels different to women than a clitoral orgasm and, as Gräfenberg previously observed, may induce an expulsion of fluid through the urethra at orgasm. In 1988, Zaviacic examined and stimulated the G spot of 27 women patients who volunteered for the study believing that their participation would assist in finding the cause of their sterility. Ten of the 27 women (37%) were induced to have urethral expulsions. However, there was a wide variation in the amount of stimulation required before the expulsion.41 There were also other studies which indicated “stimulation of the anterior vaginal wall is clearly not a prerequisite to ejaculation, although the data suggest it may be facilitated by this type of stimulation.”42

Chapter 3

RESEARCH ISSUES

FEMALE ORGASM

For the last 50 years modern science has generally accepted first Kinsey’s and then Masters and Johnson’s premise that the clitoris alone was responsible for triggering female orgasm with the pudendal nerve as the sensory pathway. They saw the creation of an “orgasmic platform” which underwent myatonic build-up which was then released during orgasm.43 However, in 1981, Perry and Whipple presented a theory of a second form of orgasm. This “uterine” orgasm “includes the Gräfenberg spot (presumed to be the female prostate) as its major source of stimulation, the pelvic nerve as its major pathway and the musculature of the uterus (in females), the bladder, the urethra, the prostate gland and the proximal portion of the pubococcygeus muscle as its major myatonic manifestation.”44

Singer and Singer go on to describe a blended orgasm which “combines elements of the previous two kinds. …it is characterized by contractions of the orgasmic platform, but the orgasm is subjectively regarded as deeper than a vulval orgasm.”45

What all of this highlights is how subjective and personal a woman’s experience of orgasm is, and how much there is yet to know about the intricacies of female orgasm, including the emotional and intellectual components. This point was made repeatedly in the comments in the questionnaires of the female subjects (see Appendix A).

In The G Spot and Other Recent Discoveries About Human Sexuality, the authors saw women’s experience of orgasm as not one way or another, correct or incorrect, but as a continuum of experience. They argue that there can be a blending of different types of orgasmic experience unique to the individual.46 One woman who is a participant in the current study has categorized and kept notes on 126 different types of orgasm to date and she is constantly finding new and more subtle variations.

URINARY STRESS INCONTINENCE

Urinary stress incontinence is considered to be a dysfunction of the bladder outlet that leads to the involuntary leakage of urine as intra-abdominal pressure is raised above urethral resistance during such activities as bearing down, coughing, sneezing, bending, or lifting heavy objects. The volume of urine leakage is generally modest at each occurrence and, in uncomplicated cases, post void residual volume is low. Urinary stress incontinence is usually a result of weakness of the muscles of the pelvic floor and/or a weakening of bladder neck supports.47

Urinary stress incontinence during sexual arousal is a poorly understood problem. There have been relatively few studies involving urinary stress incontinence and sexuality. In those there were disagreements whether the diagnosis was, in fact, urinary stress incontinence or related bladder control issues, such as detrusor instability.48

One thing that this researcher has rediscovered during this research project is the reality that much of the world views controversies such as this in an either/or framework. In this instance, one view adopted by the medical science has been that all urethral expulsions during sensual and/or sexual activity were a result of urinary stress incontinence. Another viewpoint, held by women who expel fluid during sensual/sexual arousal and their partners, was that this is a natural expulsion of fluid that does not appear to be urine and might involve a process similar to prostatic ejaculation in males. In reality, both may be the case. A 1985 study done by the New York City Beth Israel Medical Center Department of Urology concluded that, “female ejaculation may have other explanations. These include: (1) an episode of stress incontinence, (2) secretion leakage of variable amounts of fluid from Skene’s glands caused by sexual arousal or orgasm, and (3) mixed expulsion of urine and Skenean secretion.”49

Previous research has clearly shown that the lack of strength of a woman’s pelvic muscles has a correlation to incidents of urinary stress incontinence. Tested on a Perineometer, women diagnosed with urinary stress incontinence usually test in the range of from 0 to 10 mm/Hg.50

Research by Perry and Whipple has shown that female ejaculators “have significantly stronger pubococcygeal muscle contractions and significantly stronger uterine contractions than non-ejaculators.”51 In that study, utilizing the Electronic Perineometer, non-ejaculators had an average reading of 6.71 microvolts, while the ejaculators averaged 11.84 microvolts.52

THE WOMEN SUBJECTS

The problem with conducting this experiment previously has been the unavailability of test subjects who could generate the questioned fluid in a clinical environment. This researcher’s access to highly trained women who were capable of achieving the desired result under scrutiny created the opportunity for this unique experiment. All these women are very comfortable with their bodies as well as their sexuality. They also teach other women body awareness along with how to experience more sexual and sensual pleasure including G {Goddess (their terminology)} spot stimulation. They were not chosen to be statistically representative of all women but instead were chosen because, if a urethral expulsion during sensual arousal was possible, these women were the most likely to be able to produce it in a scientific environment.

The age range of the seven female subjects is 41 to 71 with the average age being 49.14 and a median age of 45. They reported having expelled fluid during sensual/sexual activity for an average of seven and two thirds years.

Most of the women subjects reported a preference in type of stimulation to orgasm, multiple orgasm and/or expulsion of fluid. In order, the preferences were: digital, then oral and, finally a combination of those two choices. In terms of penile contact, the majority reported that it only “sometimes” contributes to stimulation to orgasm, multiple orgasm and/or expulsion of fluid.

Five of the seven women subjects reported doing exercises to develop their vaginal muscles and all of those reported increased sexual responsiveness as a result. All reported contracting and/or pushing out with their vaginal muscles during sensual/sexual arousal and/or orgasm. All but one reported pushing out. The effects of this type of training are evident in the videotape record of the experiment.

Results of a pre arousal perineometer test on the current study subjects demonstrated that their average pelvic muscle strength was 26.67 mm/Hg. This was not only significantly higher than the reported average of women in general53 but particularly contrasted with women diagnosed with urinary stress incontinence.54

The experiences of the female subjects in this study provided interesting insights into ways that their body awareness has expanded their personal experience of their sexuality. Following the kind of suggestions made in The G Spot for women to exercise their pubococcygeal muscles, learn breathing techniques and push out rather than contract their muscles at orgasm, the subjects in this study reported that the intensity and duration of their orgasms have increased (see Appendix A).

Chapter 4

SOCIAL ISSUES

Important issues that need to be examined are what is known about the nature of female sexuality and orgasm and how scientific information has both been impacted by, and has an impact on, society’s construction of female sexuality. If there were to be a new scientific paradigm regarding female urethral expulsions, what social impact would it have, particularly if it were introduced as pure science and not accompanied by a new social construct that would make it useful to women’s lives.

Stating that women’s expulsions are solely the result of urinary stress incontinence is probably a vast oversimplication. The process may share common physiological attributes but what can be different is the intention and perspective of the individual woman. The same muscles, nerves, sphincters and reflexes may be involved. However, if the expulsions are viewed as natural and pleasurable and a woman feels good about her body as well as all fluids that come out of it, she can experience the expulsions more positively than a situation where these expulsions are considered “dirty“ or a malfunction of the bladder, urogenital system or any of its components.

In support of this concept, Mark Winton, in his editorial in The Journal of Sex Education and Therapy, “The Social Construction of the G Spot and Female Ejaculation,” wrote that “historically, we have discovered, ignored and rediscovered biological capabilities of women that relate to their sexuality.” He goes on to point out that the G spot and “female ejaculation” are biological issues with significant social ramifications, many as a result of society’s previous denial of these phenomena. Winton writes:

“If women are ejaculating as opposed to urinating, the implications for a woman’s sexual feelings and desires are affected to the degree that she had been misled to view a potentially pleasurable event as embarrassing and pathological. This may affect her ability to achieve orgasm and pleasure as she attempts to suppress this pseudourination. Her partner’s response to female ejaculation could also affect her sexual response.”56

It should be noted that both Kinsey and Masters and Johnson have stated firmly and repeatedly that women only have clitoral orgasms. Further, Masters and Johnson have established a great deal of professional credibility and public recognition by their description of the Sexual Response Cycle. With or without clitoral contact, G spot stimulation along with vaginal orgasm with urethral expulsion are not part of the current Masters and Johnson paradigm.

Winton also discusses the possibility of new sexual dysfunctions being created such as, “female premature ejaculation, or perhaps female retarded ejaculation or even lack of ejaculation.”57 Women, particularly in a male dominated, goal-oriented society, could put the ability to expel fluid through their urethras as one more test of whether they and their sexuality are okay.

Men might also experience some anxiety at the idea of such changing sexual potentials for women. They might become concerned that they may be less needed as sexual partners and, in an ironic twist, they might come to fear the expulsion of fluid by the woman as a signal of the end of a lovemaking session before the men are ready to have it end. Finally Winton conjectures that “A change in definition of an orgasm may be seen as complex, confusing and frightening possibility. Both men and women may find the G spot and female ejaculation as disrupting and adding new performance pressures.”58

It should be noted that, at least in American culture, there are strong negative associations with urination and defecation. Urine, of course, is sterile and not all cultures have the same biases regarding it. Winton also sees the possibility for positive effects from a closer examination of the phenomenon of “female ejaculation.” Many women could be more free of guilt and shame about “urinating” during sex with the knowledge that urethral expulsions are natural sexual bodily functions.

Another benefit of a paradigm shift that would recognize female urethral expulsions as a natural sexual bodily function could be the creation of an additional sexual activity that is not necessarily a prelude to intercourse. Our subjects and their partners reported that the process of creating a vaginal orgasm and/or a urethral expulsion separate from intercourse, is pleasurable for both the woman and a partner assisting in stimulation. Also, these sexual practices are low risk for AIDS and STDs and no risk for unwanted pregnancy.

Perhaps, the greatest potential positive effect of women experiencing a broadening of their sexuality and sexual repertoire could be the learning of new pleasurable behaviors that are without a goal other than pleasure from that activity. This is very similar to the lessons of the Masters and Johnson “sensate focus” exercises. The test subjects from the current research project reported that by taking the emphasis off intercourse and putting it onto the pleasure of each activity in the moment, that the occasions in which they do decide to experience intercourse are far more pleasurable to both parties and sometimes more frequent than when intercourse was the goal. (See Appendix A).

Chapter 5

RESULTS

Three urine/fluid samples were taken from each of the two female subjects during our second trial run on June 22, 1996 (see Table I). A baseline urine specimen was obtained before the stimulation began and both specimens showed relatively normal urea and creatinine counts.

The female subjects then began an arousal period of at least an hour in whatever manner was preferable to them before the actual insertion of the Foley catheter. The choices utilized were manual self stimulation, manual stimulation by a partner, and/or use of a non mechanical acrylic device known as a Crystal or G Spot wand. After the initial period of sexual arousal and when the subjects indicated that they were ready, the catheter was inserted, their bladders were drained and the catheter bags were changed.

The contents of the bags containing urine/fluid from the drained sample showed a substantial decrease in urea and creatinine levels, particularly in Subject #1. The rate of decrease for the contents of the bag for Subject #1 was 67% for urea and 75% for creatinine. For Subject #2, the rate of decrease was 35% for urea and 36% for creatinine.

After their bladders were drained, the women continued to be stimulated in the aforementioned manners. Over a period of an hour and a half they expelled a clear fluid in pulses, roughly coinciding with their orgasmic contractions, into the new catheter bags. The volume of fluid was approximately 540 ml for Subject #1 and 330 ml for Subject #2. Analysis of the urine/fluid from the last catheter bags showed virtually the same urea and creatinine levels for Subject #1 and an additional drop of 17% urea and 21% creatinine for Subject #2. Therefore, the total rate of decrease from the baseline urine specimen to the post draining urine/fluid captured in the last catheter bag for Subject #1 was 67% for urea and 75% for creatinine. For Subject #2, the total rate of decrease was 52% for urea and 57% for creatinine.

A glucose test was run on the urine/fluid samples from both subjects from June 22, 1996 and, while some earlier studies showed a rise in glucose from the baseline urine sample to the expelled fluid, in these subjects the glucose level remained relatively constant.

In the case of Subject #2 on June 22, 1996, there was a point in time in which there was an unmistakable expulsion of approximately two cc of milky-white fluid through the urethral meatus and completely surrounding the outside of the catheter tube. Unfortunately, the research team was unable to capture a sample of this fluid for analysis and the lighting for the videotape was insufficient to show the expulsion.

On Saturday, July 27, 1996, six female subjects were tested at a facility in Tiburon, California. Subject #1 was a retest of Subject #2 from June 22, 1996. A baseline urine sample was taken and a perineometer test was performed on the female subjects upon their arrival at approximately noon (see Tables II and III). During the next two hours an orientation took place as to the procedures to be followed. Questions were answered and concerns were addressed.

At approximately 2:00 PM, an arousal period was begun for the female subjects with a variety of methods available to achieve that end. The choices that were utilized were manual self stimulation, manual stimulation by a partner, and/or use of a non mechanical acrylic device known as a Crystal or G Spot wand. When the subjects felt that they were sufficiently aroused and indicated that they were ready to begin the experiment, they were ushered into the first available examination room. Arousal was then resumed in the aforementioned manners until the female subjects indicated that they were ready to have the catheter inserted and their bladders drained. Stimulation was then resumed with the subjects instructed to attempt to achieve an expulsion of fluid in a manner similar to their normal patterns.

In all six cases, the female subjects expelled substantial amounts of fluid from their bladders, post draining, in pulses roughly coinciding with their contractions, through the catheter tube and into the storage bag. These amounts ranged in volume from approximately 50 ml for Subject #5 to 900 ml for Subject #1. In all cases, the urea and creatinine levels of the fluid expelled after the draining of the bladder were substantially lower than the levels for the same components in the baseline urine specimen by an average of 72% for urea and 76% for creatinine. In a number of cases, the urea and creatinine levels decreased substantially just between the baseline and drained specimens. In the case of Subject #1, after an hour of stimulation, the catheter tube and inflated balloon were expelled. A new catheter tube was inserted and a new post-draining bag was started. Laboratory results are in Table II.

As for any fluid that came from the urethral opening but outside of the catheter tube, attempts were made by the medical team to capture the fluid by drawing it into a 10 cc syringe or catching it with a laboratory specimen container. The research team saw clear visual evidence, recorded by the videotape, of milky-white, mucous-like emissions from the urethra outside of the catheter tube for subjects #1, 3 and 8.

Trace amounts of fluid from outside the catheter tube were captured from subjects #1, 2 and 3 but were insufficient in volume for the laboratory to test. The samples were frozen and are being stored should the opportunity become available to test these tiny amounts. In a fourth instance, Subject #8 produced approximately 1 cc of a clear, thick liquid that tested negative for fructose and glucose. Urea and creatinine levels were slightly lower but similar to those of the same subject’s fluid expelled into the catheter bag subsequent to her bladder being drained. It is possible that the 1 cc of fluid in question represented leakage from the point where the bladder neck met the catheter balloon.

In the case of subject #3, the research team completely overlooked an apparent emission at the end of the testing session that is clearly shown by two of the three video cameras. No comment was made at the time nor was any movement made towards collection of a sample of that emission. In reviewing the videotape, it would appear that a number of factors contributed to our not being aware of what was taking place. First, the subject was very quiet and gave no verbal indication of an impending orgasm. Secondly, the subject’s husband was wearing a white latex glove while gently tapping on her clitoris at the time of orgasm. He left his finger in a down position on her clitoris for a few seconds after the orgasm and it is not until he raises his finger that the viewer is able to see the milky-white, mucous-like fluid. In real time, it was probably missed because of the lack of color contrast with the glove. Also, the video cameras, with their zoom lenses, amplified the emission, making the event easier to see.

In five of the seven subjects (Subjects #2, 3, 7, 8 from 7/27/96 and Subject #1 from 6/22/96), the research team observed the phenomenon referred to as eversion.59 This occurs when the urethral meatus appears to push outward and becomes very visible just prior to orgasm. In Addiego et al, it was stated that this occurred when the Gräfenberg spot was stimulated. It should be noted that Subject #3 at no time utilized G spot stimulation and still exhibited signs of eversion. Also, Subject #7 exhibited eversion with only clitoral and anal stimulation and then with clitoral, Gräfenberg spot and anal stimulation.

Table IIIPerineometer Readings from July 27, 1996 Testing

Subject

Time In

Relax

Contract

Muscle
Strength

1

12:13 pm

28

40

12

2

12:32 pm

14

42

28

3

12:28 pm

20

42

22

5

12:22 pm

16

40

24

7

12:07 pm

20

62

42

8

12:16 pm

24

56

32

Muscle strength was registered on a Perineometer as the change in pressure measured in millimeters of mercury (mm/Hg) between the average of six 10-second contract scores, minus the average of six 10-second relax scores.

Chapter 6

CONCLUSIONS

The analyses of the post draining fluid that came through the catheter tube into the storage bags raised some interesting questions. While the results were consistent with the earlier studies done in the 1980’s showing lowered urea and creatinine levels, no signs of any prostatic components such as fructose or glucose were detected. What is different here is that, because of the catheter, it can be assumed that this fluid came from the bladder. In the earlier studies where no catheter was used, it was possible that the fluid obtained was a combination of urine from the bladder and fluid expelled from the urethral glands and ducts, mixed together in the urethra. The earlier lab tests also showed the presence of substances not at the time thought to be present in female urine and present in male prostatic fluid such as fructose.

Therefore, the primary conclusion from the experiment is that, at least for these seven women, all knowledgeable and experienced ejaculators, the fluid expelled through the catheter tube and into the storage bag unquestionably came from their bladders. Even though their bladders were drained, they still expelled from 50 ml. to 900 ml of fluid through the tube and into the catheter bag. The only reasonable conclusion would seem to be that the fluid came from a combination of residual moisture in the walls of the bladder and from post draining kidney output. While fluid intakes were not monitored, it should be noted that the subjects were given water or soft drinks as requested and that no one was viewed drinking large quantities.

It is important to note the consistency of results that showed a greatly reduced concentration of urea and creatinine in the expelled fluid. The clear inference is that the expelled fluid is an altered form of urine and that there is a process that goes on during sensual/sexual stimulation and excitement that changes the chemical composition of urine. There have been some indications, and this is certainly a basis for a follow up study, that the hormone aldosterone and/or elevated blood pressure during sensual/sexual activity might contribute to a lowering of urea and creatinine levels.

While on several occasions there was evidence of milky-white, mucous-like emissions from the urethra outside of the catheter tube which were recorded on video tape, only a small portion of this fluid could be captured for laboratory analysis. An objective reading of the previous literature, particularly the pathology reports from Zaviacic, indicates the possibility of such an emission from the urethral glands and ducts which would hypothetically be merging with the expelled fluid from the bladder in the urethra. This seems promising enough to encourage future research employing this study’s methodology of arousing the subjects and then utilizing a Foley catheter to segregate the urethra from the bladder.

In the past, the assumption has been that female urethral expulsions during sensual and/or sexual activity originated either in the bladder or from the urethral glands and ducts. The current study would indicate, as was suggested by Zaviacic60 and in the Beth Israel study,61 that both may be the case. In some women, there may be an emission from the urethral glands and ducts which merges in the urethra with fluid from the bladder. This would explain the seemingly contradictory results from previous studies. In the cases where prostatic fluid components were discovered, a urethral expulsion may have also taken place. In other instances, where there was just fluid with lowered amounts of urea and creatinine, an expulsion from the bladder only may have been involved. In the subjects in the Goldberg, et al, study where there were neither prostatic fluid components nor lowered urea and creatinine levels, the authors may have been correct in their explanation that the subjects may have simply been nervous and may not have been sufficiently aroused to alter urea and creatinine levels.62

Chapter 7

COMMENTARY AND SUGGESTIONS FOR FUTURE RESEARCH

The one clearly unresolved issue from the current study is the question of whether some women secrete fluid from their urethral glands and ducts during sensual/sexual arousal. While the research team saw evidence of such a secretion on several occasions, the amount of the secretion was so small and happened so quickly, that in most cases the research team was unable to effectively capture a sample for analysis. New collection procedures should be considered for any future research including, but not limited to, some form of suction device and/or the possibility of obtaining a swab and culture.

Another research problem that was encountered was the difficulty of obtaining the desired specialty specimen analyses from commercial laboratories whose testing protocols are set up for diagnostic purposes and not for research analysis. The cooperation of university research laboratories in this endeavor would be and would have been enormously valuable.

Another suggestion for any future research would be to devise protocols for testing the effects of aldosterone on urea and creatinine levels during sensual/sexual arousal. Also, the active participation in any future study of a qualified urologist with sufficient sexological training would be very helpful.

While this has been a very interesting project from the biological side, the one thing that emerged clearly for this researcher was that in the real world the crucial issue was not the composition of the urethral expulsions but, instead, a far more fundamental and human question which is simply “How do women feel about their bodies and everything that comes from them?” In that regard, this researcher hopes that the current study was able to make a contribution.

Dorschner, W. and Stolzenburg, J. U. A new theory of micturition and urinary continence based on histomorphological studies and The musculus ejaculatorius: a newly described structure responsible for seminal emission and ejaculation. Utologia Internationalis, 53 (1):34-7, 1994.

7. If the answer to number 6 was yes, place a number (1, 2, 3, etc.) indicating the number of pregnancies you have had which were resolved in the following ways:
childbirth(s) (1) 1; (2) 4; (3) 1; (5) 1
miscarriage(s) (3) 0; (4) 1
abortion(s) (1) 2; (3) 6; (5) 2

Directions: Place an (x) in the box on the rating scale which best describes your most accurate response. Note: In the following questions with numbers 1-5 on the accompanying chart, No. 1/always – indicates a percentage of approximately 100%; No. 2/often – indicates a percentage of approximately 75%; No. 3/sometimes – indicates a percentage of approximately 50%; No. 4/seldom – indicates a percentage of approximately 25%; No. 5/never – indicates a percentage of approximately 0%.

2. Do you ever expel fluid at any other time than when you are having an orgasm?
Often (1) (3) (5) (7)
Sometimes (2) (4) (8)

3. Consider each of the following methods of stimulation and rate each as it presently contributes to your achieving orgasm. Place an (x) in the box in the right hand column if you have not had the experience.

4. When during your menstrual cycle are the pleasurable sensations associated with this sensitive area in your vagina most easily detectable? (Circle Number)
1. Just before menstrual period
(8) 2. During menstrual period
3. Just after menstrual period
(3) 4. Midway between menstrual periods
5. No difference during menstrual cycle
(2) 6. No difference, had hysterectomy with removal of uterus only
(7) 7. No difference, had hysterectomy with removal of ovaries and uterus
(1) (4) (5) 8. Not aware of difference in menstrual cycle when pleasurable sensations occur

5. Consider each of the following methods of stimulation and rate each as it presently contributes to your achieving multiple orgasms. Place an (x) in the box in the right hand column if you have not had the experience.

6. Consider each of the following methods of stimulation and rate each as it presently contributes to your ability to expel fluid. Place an (x) in the box in the right hand column if you have not had the experience.

(4) Outer 1/3 is properly aroused when middle 1/3 is highly sensitive
4. Have you ever done any exercises for the primary purpose of developing the vaginal muscles? Please check answer below and follow the directions next to the answer you check.
 Yes (1) (2) (4) (3) (5)
 No (7) (8)

5. Briefly describe the following with respect to the vaginal exercises:
A. Reason(s) for beginning the exercises:
(1) Pregnancy; before that unbeknownst to me dancing exercised muscles;
(2) Fun; (3) to be able to turn my pussy inside out – show “G spot”
(4) pleasure enhancement (5) Pregnancy
B. Estimate your approximate age(s) during which you performed vaginal exercises:
(1) 20 +; (2) 55; (3)44; (4) 34 on up to 41; (5) 28
C. Type of exercises performed:
(1) Kegels; Tantric Yoga; pelvic floor type flexing; dance (rock & roll)
(2) Kegels (3) practiced pushing out when I felt myself coming
(4) working w/3 muscle groups; (5) 100 squeezes per day at least
D. Longest period of relatively consistent exercise (weeks, months, etc.):
(1) Not an exercise program; (2) 1 week; (3) 2 years now;
(4) a few months – maybe-fairly irregular (5) 16 years
E. Average number of exercises and/or amount of time spent exercising each day:
(2) Once per day; (3) five or so times a week (almost daily, about a half hour)
(4) 30 minutes (5) 1-5 per day/5-10 minutes

6. Significant changes in sexual responsiveness, if any, which you feel are at least partly attributable to the exercises:

7. When experiencing an orgasm, do you contract or push out with your vaginal muscles?
 Yes (1) (2) (3) (4) (5) (7) (8)  No (proceed to question 8)
 Contract (1) (2) sometimes; (4) (5) (7)
 Push out (1) (2) when expelling fluid; (3) (4) (5) (7) (8)
Comments (1) depends on whether I want to “pop” or ride the “wave”
(3) I contract until I feel the orgasm coming then I push out as it begins
(4) I like to do both (5) both at different times – mostly push out
(7) seems to be a key factor with ejaculating

8. When experiencing an orgasm, do you practice any specific form(s) of breath patterns?
 Yes (1) (3) (4) (5) (7) (8)  No (2)
Description (1) breathing into feeling
(3) I make sure to not hold my breath – blow out slowly
(4) Panting at first, then at the moment of climax, I breathe deep, long and slowly
(5) Cobra breath sometimes or deep belly breathing circulating energy through chakras very consistently
(7) try to breathe out and push out vaginal muscles
(8) sometimes I will reverse breathing to do more deep “Lori (Grace)” breathing – in = swelling abdomen; out = shrinking abdomen

9. Have you noticed any particular physical characteristic(s) possessed by one or more of your partners which has enhanced the sexual experience for you?
(1) ability to “dance” with me and channel energy and breathe and go “deep into the moment”
(2) No
(3) My partners who talk naughty and/or comment favorably about what my genitals look or feel like get A+ grades; plus fingers that are sensitive and move slowly (not ham-handed)
(4) Yes, a penis that has an upward curve when erect and hits my G-spot w/ease.
(5) Many – ! self confidence, caring, tender yet strong, lasting longer, being very present, very touching (& appreciative & expressing that) of my whole body, vulnerability, connected with his feelings and mine, communicative, open heart, creative, experimental, playful, sincere, communicates his feelings through eye contact as well as verbal
(7) Skill! Focused attention. Sensitivity to my response and energy.
(8) Endurance, attention, testosterone – sensitivity – but now this is mind/body

C. Have you ever had bladder problems or urinary stress incontinence?
(1)  Yes (1) (2) (7)
 No (3) (4) (5) (8)
(2) Have you ever been treated for this problem?
 Yes (7)
 No (1) (2)
(3) Please describe the diagnosis (what it was called), how it was treated, how long it took to be corrected, and if both partners were treated.

Type treatment: (1) exercises; (7) pyrridium and bactrim
Length of time to be corrected: (7) 5 days
Were both partners treated? Yes  No (1) (7)
(4) Has the problem recurred? Yes (1) (7) No  If you answer was yes, approximately how often has it recurred? (1) less than before; (7) 4 or 5 times

(5) At what age(s) did you experience the problem(s)?
(1) after age 32; (7) 54 and 55
D. Have you ever found coitus to be painful?
 Yes (1) (2) (3) (4) (5) (7)
 No (8)

If yes, are there any particular circumstances in which this occurs? (Position, timing, etc.) Briefly describe below:
(1) level of relaxation and trust and preparation and lubrication
(2) only when penis is too large and male thrusts too hard
(3) If I have yeast, my skin tears
(4) When first entered if I am not warmed up
(5) Well, one time or two briefly certain position and I think there was an infection of cervix present
(7) When I had the endometriosis

11. Please complete the following time-line relative to position(s) during coitus. Enter, in the spaces provided, the two most orgasmically beneficial sexual positions for you during each of the time periods below: Note: the first category, pre-vaginal sensitization, refers to the time in your sexual life when you may have thought that your vagina was not very sensitive to stimulation. If this has never been the case, mark an (x) through the two pre-vaginal sensitization spaces. In the other three categories, note the coital positions you favored in terms of orgasmic response after you became vaginally sensitive, multiorgasmic or began to expel fluid. The positions may be the same in each category or may differ.
PERIODS OF SEXUAL RESPONSE MOST ORGASMIC POSITIONS

Pre-vaginal sensitization 1. (1) (3) missionary; (2) on my back; (4) standing embrace, full body; (5) no one position; (7) I had no orgasms during this time ( 17-19 years old); (8) on top of man

2.(3) Me on my back, him on his side; (4) on top of partner, he lap down; (5) missionary, my feet on his shoulders, him kneeling over me; (7) male on top, up on arms, holding my legs back; (8) on top
___________________________________________________________________________

Multiorgasmic 1. 1) missionary; (2) (5) on my back; (3) doggy; (4) on my back, legs up around shoulders, also partner standing at edge of table;(7) Male enters from behind – ass up; (8) missionary
2. (3) Me on my back, him on his side; ; (4) on top of partner, he lap down; (7) male on top, up on arms, holding my legs back; (8) on top
___________________________________________________________________________

Expelling fluid 1. (1) missionary; (2) on my back; (3) doggy; (4) only through manual stimulation; (5) spoon position, on all fours or from behind(on knees, entered from behind); (7) Male enters from behind – ass up; (8) missionary
2. (1) F on top; (3) Me on my back, him on his side (my legs up over his top side); (4) orally not w/intercourse yet; (5) missionary, my feet on his shoulders, him kneeling over me; (7) male on top, up on arms, holding my legs back; (8) on top
___________________________________________________________________________
PART III

1. When you expel fluid during orgasm, are these orgasms more or less sexually gratifying than when you do not expel fluid. Orgasms with expelling fluid are: (Place an (x) under the number which corresponds to your most accurate response)

Most Gratifying Uncertain Less Gratifying
1 2 3 4 5

(2) (7) (3) (4) (5) (1) (8)

2. After the first orgasm in which you expel fluid, do you continue to expel fluid with each succeeding orgasm? (Place an (x) under the number which corresponds to your most accurate response)

Always Somewhat Sometimes Seldom Never

(2) (7) (3) (4) (1) (8)

(5) not always expelling fluid at time of orgasm

3. How does the fluid expelled during your orgasms appear to be in terms of consistency, when compared to your lubricating fluid secreted during sexual excitement? Fluid expelled is: (Place an (x) under the number which corresponds to your most accurate response)

Much thinner Somewhat thinner About the same Somewhat thicker Much thicker

(1) (2) (4)(8) (3) (5) (7) (5)

4. How does the fluid expelled during your orgasms appear to be in terms of consistency, when compared to the fluid that the male ejaculates? Fluid expelled is: (Place an (x) under the number which corresponds to your most accurate response)

Much thinner Somewhat thinner About the same Somewhat thicker Much thicker

8. Have you ever checked the aroma (smell) of the fluid that you expel?
 Yes (1) (3) (4) (5) (7) (8)
 No (2)

If yes, briefly describe the aroma as perceived by you:
(1) hard to describe;
(3) smells like my genitals secretions normally smell but fresher and more watery, mixed with some urine usually;
(4) initially a bit like urine, after the first expulsion it becomes more neutral or milky;
(5) musky; (7) no aroma; (8) range – zero to musky

9. What do you believe to be the source of this fluid at the time of your orgasm?
Please describe and refer to anatomical chart on page 6.
(1) All I know is it comes from vaginal region
(2) Don’t know – comes out urethra
(3) Some urination from urethra and it feels like the rest of it comes up from halfway up the inside of my vagina
(5) About a third of the way inside the vaginal upper wall thick fleshy area swells (it ___ w/fluid and pushes out from there)
(7) It feels like it comes out of the walls of the vagina
(8) Don’t know — don’t think it is urine, must be some other gland

10. During the fluid expelling phase of sexual activity, have you ever had any negative responses from your partner?
 Yes (1) (2) (8)
 No (3) (4) (5) (7)

10. A. If yes, did this occur during your partner’s first experience with this phenomenon?
Yes  (1) (2) No  (8)

B. If you continued the relationship, did your partner’s negative reaction continue?
Yes  (1) No  (2) (8)

C. Briefly describe what you feel were the basic reasons for your partner’s negative response(s): (1) At first, lots of shame. Thought I wasn’t in control of urine; (2) Ignorance; (8) Thought it was urine (not my regular partner)

If yes or no, briefly describe your reasons for feeling this way:
(1) Thought I wasn’t in control of urine; (2) Ignorance; (5) I had read about it by then and knew what to expect; (8) I believe that sex is sacred and all that happens is sacred during sex

In the same situation described above:
A. Would you be multiorgasmic?  Yes (1) (2) (3) (4)(5) (7) (8)  No

B. Approximately what length of time after the initial use of these two techniques are you able to achieve orgasm with expelling fluid? (Answer in terms of second, minutes, etc.)
(1) 10-15 minutes; (2) 5-10 minutes; (3) On a “hot” day, 2 minutes; normally, 5-10 minutes; (4) from 10 seconds to a few minutes; (5) never timed it, couldn’t say, too varied; (7) 3-4 minutes; (8) 5 seconds

C. Do you usually expel fluid with the first orgasm?  Yes (3)
 No (1) (2) (4) (7) (8)
Sometimes (5)

D. After the first orgasm in which you expel fluid, do you continue to expel fluid with each succeeding orgasm?
 Yes (2) (3) (4) (7)
 No (1)
(5 ) not always at time of peak orgasm
(8) sometimes

If yes or no, briefly describe how this ability or inability makes you feel:
(1) powerful
(2) Once in a while ( I experience) performance anxiety if a man expects it (expel fluid). But (it is) pleasurable for me whether or not I expel fluid.
(3) I’d be able to control the fluid by backing off of strong sensations or by contracting or by stopping the sexing but why would I want to exercise this control?
(4) When I feel relaxed I can let go easily but when circumstances are not real safe, I can and will hold back
(5) Great, want more ability
14. Is there any information regarding either the expulsion of fluid or any other relevant subject that you can think of that has not been covered in previous questions about which you would comment.

(3) My connection to my partner’s penis (either in my hand or in my mouth) carries a very strong influence on my ejaculatory behavior.
(4) Yes. When I feel emotional intimacy which brings about the richest rewards in orgasmic ejaculate. Amrita sometimes seems to come from the brain and wash straight through the entire body on its way out.
(5) This questionnaire seems to suppose that the expulsion happens with orgasm. That is not my experience or that of other women I have talked with. Expulsion happens without orgasm before – also has happened in erotic dance contact (could be incontinence) – has happened while giving oral sex to male partner – more regularly through with digital stimulation as with wand and oral sex or clitoral stimulation – it all depends on all the stimulation and foreplay around it and how I’m feeling emotionally with my partner. Does my heart feel safe to come out and play – then it happens in penis penetration as well or other.
(7) There may be an additional “G spot” accessed through the anus.
(8) I have gone for 7 hours coming & expelling fluid w/out drinking any water.

This questionnaire contains selected items from the survey instrument, “Perceptions of Female Sexual Response Patterns” by J. Kenneth Davidson, Sr., Carol Anderson Darling, Florida State University, and Colleen Conway-Welch, Vanderbilt University which are being used by permission of the authors.